Collaboration and cooperation systems to prevent suicide among children in Japan: effective use of the Observe-Orient-Decide-Act loop

Suicide among school-age children is a significant problem in Japan, particularly exacerbated by the COVID-19 pandemic. This has disrupted school-based support services and increased children's stress and anxiety. Effective collaboration between schools and medical/welfare services is essential, but teachers face high workloads and stress, leading to high absenteeism. This study proposes the OODA loop, a rapid decision-making model, as a more effective alternative to the existing Plan-Do-Check-Act (PDCA) cycle for managing high-risk children. The PDCA cycle is deemed inefficient in rapidly changing situations, while the OODA loop's iterative nature allows for quicker responses and adjustments. The study aims to assess teachers' and other professionals' perceptions of their health, attitudes toward the OODA loop, and satisfaction with current collaborative practices to establish a baseline for incorporating the OODA loop into existing systems. The OODA loop has been successfully implemented in other fields such as military strategy, disaster management, and healthcare, but its application to education-related interprofessional collaboration remains unexplored. The research hypothesizes that adopting the OODA loop framework will improve the speed and effectiveness of interventions, leading to better outcomes and reduced stress on teachers.

Existing literature highlights the critical need for improved collaboration between schools and community services to support children's mental health, particularly in the context of increased stress due to the COVID-19 pandemic. Studies in Japan have underscored the challenges faced by overworked teachers, leading to high rates of absenteeism due to mental health issues. Research on interprofessional collaboration in social work and healthcare emphasizes the importance of strong professional identities, clear organizational structures, and effective communication. While the PDCA cycle is commonly used in education for individual support plans, its limitations in handling unexpected events and the time-intensive planning phase have been noted. In contrast, the OODA loop, a dynamic decision-making model, has shown promise in various fields for its adaptability and speed in emergency response. This study draws on research demonstrating the effectiveness of the OODA loop in fields such as healthcare and cybersecurity, advocating for its application to the educational context for improved crisis management and reduced teacher stress. The researchers also reference existing literature on interprofessional collaboration in education and healthcare, noting variations in the level of collaboration and highlighting the challenges of coordinating efforts between different professions.

This study employed a quantitative and qualitative approach using an anonymous, self-administered questionnaire survey. The sample comprised 205 teachers, nurses, welfare professionals, and school counselors from five Japanese cities, with 171 providing valid responses (83.4% response rate). Data collection occurred between October 2021 and October 2022, distributed at schools, training seminars, and case study meetings. The questionnaire assessed self-rated health (physical and mental), depressive symptoms using the Japanese version of the Kessler Psychological Distress Scale (K6), and attitudes towards collaboration and cooperation. Self-rated health was evaluated using a four-point scale (1: very healthy to 4: not healthy). The K6 scale, a six-item instrument, measures the severity of depressive symptoms. The researchers also developed an original 17-item scale to measure attitudes towards using the OODA loop for collaboration, focusing on aspects such as flexible situational assessment, group information sharing, and self-monitoring. Factor analysis was performed on the OODA loop attitude scale, revealing three main factors. Point-biserial correlation analysis examined the relationship between the OODA loop factors and satisfaction with current collaborative practices. A t-test determined differences in self-rated health, attitudes, and K6 scores between those who had and had not collaborated, as well as between those who were satisfied and dissatisfied with current collaborative efforts. Qualitative data analysis of free-text responses regarding reasons for satisfaction/dissatisfaction was conducted by five researchers, classifying them into categories related to collaboration details, methods, and organization. Statistical analysis was performed using SPSS Statistics 28.0J.

The study found no significant differences in mental health status among participants based on profession, experience with collaboration, or satisfaction with current collaboration. However, those dissatisfied with the current collaborative efforts reported poorer self-rated physical and mental health than those satisfied, although there were no significant differences in depressive symptom levels (K6 scores). Factor analysis of the OODA loop attitude scale revealed three reliable and valid factors: flexible and independent situational assessment, group monitoring and sharing, and self-monitoring. Participants dissatisfied with the current collaborative system scored significantly lower on all three OODA factors. Qualitative analysis of the free-text responses identified three categories of reasons for satisfaction or dissatisfaction: details of collaboration, methods of collaboration, and organization of collaboration. Those satisfied with collaboration highlighted sufficient information sharing, appropriate advice, smooth case management, and organizational unity, while those dissatisfied cited insufficient information, slow responses, lack of solutions, organizational dysfunction, and lack of sufficient staff. Significant positive correlations were observed between all three OODA loop factors and satisfaction with current collaborative practices.

The findings indicate a strong relationship between satisfaction with existing collaborative systems and self-rated health, suggesting that improvements in collaborative processes can positively impact the well-being of educators. The lower OODA loop scores among dissatisfied participants highlight the need to promote a more proactive and adaptive approach to collaboration. The qualitative data emphasizes the importance of sufficient information exchange, effective communication, efficient case management, and clear organizational structures. The preference for proactive and adaptable responses to situations rather than following rigid plans points towards the suitability of the OODA loop as a framework. The study's findings suggest that adopting the OODA loop's rapid and iterative approach could enhance the responsiveness of collaboration and cooperation, potentially reducing teacher stress and improving overall effectiveness in supporting high-risk children. The absence of significant differences in depressive symptoms between satisfied and dissatisfied participants highlights the importance of addressing self-rated health even in the absence of clinically significant depression.

This study demonstrates a clear link between satisfaction with collaborative practices and mental health among educational professionals involved in child suicide prevention. The OODA loop shows promise as a more effective model for collaboration than the current PDCA cycle. The researchers recommend raising awareness of the OODA loop among teaching staff, establishing clear organizational structures for collaboration, and creating systems for organic collaboration between schools and medical/welfare institutions. Future research should explore the practical implementation of the OODA loop in different educational settings and conduct in-depth interviews to gather richer qualitative data. Further investigation into the perspectives of external support institutions is also warranted.

This study's limitations include the sample size and geographical scope, focusing on five cities rather than a nationally representative sample. The use of a questionnaire survey may have limited the depth of insight compared to qualitative methods like interviews. The study's focus on a Japanese context means that its findings may not be directly generalizable to other cultures. Future studies should address these limitations by employing larger, more diverse samples, incorporating qualitative data collection methods, and conducting cross-cultural comparisons.